Provider Demographics
NPI:1568473304
Name:BECKER CLINIC LTD
Entity Type:Organization
Organization Name:BECKER CLINIC LTD
Other - Org Name:BECKER CLINIC OF CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINIC MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:WADE
Authorized Official - Last Name:POWELL
Authorized Official - Suffix:
Authorized Official - Credentials:RT
Authorized Official - Phone:540-563-0334
Mailing Address - Street 1:6206 PETERS CREEK ROAD
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24019
Mailing Address - Country:US
Mailing Address - Phone:540-563-0334
Mailing Address - Fax:540-563-0122
Practice Address - Street 1:6206 PETERS CREEK ROAD
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24019
Practice Address - Country:US
Practice Address - Phone:540-563-0334
Practice Address - Fax:540-563-0122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104000126111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
025540OtherANTHEM
025540OtherANTHEM